Was the patient infected before or after being admitted to hospital? Hospitals are full of sick…

Was the patient infected before or after being admitted to hospital? Hospitals are full of sick people and are therefore inherently risky places in terms of their potential for disease transmission. Of course hospitals do their best to minimize this risk but hospital – acquired infections, also called nosocomial infections, are not unusual among even the most hygienic of institutions. Where these nosocomial infections cause serious illness or death and it can be proved that the hospital was not providing good hygienic practices it is probable that litigation will follow. Consequently, it is

Was the patient infected before or after being admitted to hospital? Hospitals are full of sick people and are therefore inherently risky places in terms of their potential for disease transmission. Of course hospitals do their best to minimize this risk but hospital – acquired infections, also called nosocomial infections, are not unusual among even the most hygienic of institutions. Where these nosocomial infections cause serious illness or death and it can be proved that the hospital was not providing good hygienic practices it is probable that litigation will follow. Consequently, it is important to be able to prove whether or not a patient was infected before or after they entered the hospital. Most of these infections involve microbes such as MRSA but occasionally they involve myiasis. Hiraet al. (2004)provide an interesting case of this involving a young boy admitted to a teaching hospital in Kuwait following a traffic accident. On admission the child s face was covered in blood, he was badly injured and remained comatose in the intensive care unit over the following days. The nursing staff noticed maggots emerging from the child s nose on days 4 (96 hours) and 5 (120 hours) after admission and fi ve of these were collected. They also described seeing a green fl y perched on the child s nose on day 5 but neither this nor some maggots seen on the child s ear were captured. The maggots were identified as Lucilia sericata and the eldest was a third instar, one was in the process of moulting to the third instar and the others were second instars. It was therefore concluded that the infesting larvae were coming to the end of their second instar. According to Greenberg (1984) , L. sericata can be reared from egg laying to the end of the second instar in 50 hours at 29 C and above this temperature their development rate is even faster. Consequently, even assuming a nasal temperature of 30 C rather than a body temperature of 37 C, any eggs laid on the child before he entered the hospital would have had ample time to complete their third instar and/or be vacating the wound in search of a pupation site. The infection was therefore most likely acquired in the hospital and although the green fly was not identified, its presence in the intensive care unit indicated that it was possible for flies to enter the premises.

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